许丹霞,陈强,章尧,柴玮璐,张同龙,蒋天安,赵齐羽.超声引导下经皮穿刺活检诊断胰腺实性病变[J].中国医学影像技术,2024,40(4):494~497
超声引导下经皮穿刺活检诊断胰腺实性病变
Ultrasound-guided percutaneous biopsy for diagnosing solid pancreatic lesions
投稿时间:2023-12-18  修订日期:2024-01-02
DOI:10.13929/j.issn.1003-3289.2024.04.004
中文关键词:  胰腺肿瘤  超声检查  活组织检查
英文关键词:pancreatic neoplasms  ultrasonography  biopsy
基金项目:国家自然科学基金(82171937)。
作者单位E-mail
许丹霞 浙江大学医学院附属第一医院超声医学科, 浙江 杭州 310000  
陈强 浙江伽奈维医疗科技有限公司研发部, 浙江 杭州 310000  
章尧 浙江伽奈维医疗科技有限公司研发部, 浙江 杭州 310000  
柴玮璐 浙江大学医学院附属第一医院超声医学科, 浙江 杭州 310000  
张同龙 浙江大学医学院附属第一医院超声医学科, 浙江 杭州 310000  
蒋天安 浙江大学医学院附属第一医院超声医学科, 浙江 杭州 310000  
赵齐羽 浙江大学医学院附属第一医院超声医学科, 浙江 杭州 310000 derman2000@zju.edu.cn 
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中文摘要:
      目的 观察超声引导下经皮穿刺活检诊断胰腺实性病变的效能,探讨诊断准确率影响因素。方法 回顾性分析746例因胰腺实性病变接受经皮超声引导下粗针穿刺活检(US-CNB)患者,记录临床及影像学资料、胰腺穿刺相关资料和病理诊断;以穿刺12个月后临床随访结果为最终诊断,评估US-CNB诊断胰腺实性病变的效能。以单因素分析及logistic回归 分析筛选影响US-CNB诊断准确率的因素。结果 742穿刺活检成功,技术成功率99.46%(742/746)。US-CNB准确诊断706例(准确组)、不准确36例(不准确组),其诊断胰腺实性病变的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为95.25%(702/737)、80.00%(4/5)、95.15%(706/742)、99.86%(702/703)和10.26%(4/39)。31例(31/742,4.18%)发生轻度并发症,4例(4/742,0.54%)发生严重并发症。组间患者年龄,胰腺病灶最大径<2 cm、病灶边界不清晰及病灶位于胰头部占比差异均有统计学意义(P均<0.1)。回归分析显示,病灶最大径<2 cm是US-CNB诊断准确率的独立影响因素(OR=3.054,P=0.030)。结论 超声引导下经皮胰腺病变穿刺活检安全、可靠,但病灶体积小可能影响其准确性。
英文摘要:
      Objective To observe diagnostic efficacy of ultrasound-guided percutaneous biopsy for solid pancreatic lesions, also to explore the impact factors of diagnostic accuracy. Methods Data of 746 patients with solid pancreatic lesions underwent ultrasound-guided core needle biopsy (US-CNB) were retrospectively analyzed. Clinical data, imaging records, pancreatic puncture-related information and pathological diagnosis details were collected. After 12 months follow-up, the final clinical diagnoses were assessed, and the efficacy of US-CNB for diagnosing solid pancreatic lesions was evaluated. Univariate analysis and logistic regression analysis were used to screen impact factors for US-CNB diagnostic accuracy of solid pancreatic lesions. Results US-CNB was successfully performed in 742 cases, with the technical success rate of 99.46% (742/746). US-CNB accurately diagnosed pancreatic lesions in 706 cases (accurate group) but inaccurately judged 36 cases (inaccurate group). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of US-CNB for diagnosing solid pancreatic lesions was 95.25% (702/737), 80.00% (4/5), 95.15% (706/742), 99.86% (702/703) and 10.26% (4/39), respectively. Mild post-procedural complications occurred in 31 cases (31/742, 4.18%), while severe complications observed in 4 cases (4/742, 0.54%). There were significant differences of patients' age and the ratio of lesions with the maximum diameter <2 cm, with unclear boundaries or located in the head of pancreas between groups (all P<0.1). Regression analysis showed that the maximum diameter of lesion <2 cm was the independent impact factor of the accuracy of US-CNB for diagnosing solid pancreatic lesions (OR=3.054, P=0.030). Conclusion Ultrasound-guided percutaneous biopsy of solid pancreatic lesion was safe and reliable, but its accuracy might decrease in small size lesions.
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